Clinical trials

The current study is a double-blind, parallel-group randomized controlled trial involving 80 participants with chronic low back pain. The trial will compare a program of Pain Neuroscience Education plus Sensory Discrimination Training and core stability exercises with a program of Pain Neuroscience Education and core stability exercises alone. Interventions will be delivered twice weekly for eight weeks. The primary outcome is pain catastrophizing. Secondary outcomes include kinesiophobia and functional movements. Assessments will be conducted at baseline, 4, and 8 weeks. The trial will be carried out at Nutricao Lahore Clinic and Model Town Hospital, Lahore. The hypothesis is that Pain Neuroscience Education with Sensory Discrimination Training will result in greater reductions in pain catastrophizing and kinesiophobia, as well as improvements in functional movements.

Temporomandibular disorders (TMDs) are among the most common musculoskeletal conditions affecting the craniofacial region and are characterized by pain, joint sounds, restricted movement, and functional limitations. Anterior disc displacement is one of the most frequently observed temporomandibular joint (TMJ) disorders and is classified as anterior disc displacement with reduction (ADDwR) or without reduction (ADDwoR). In ADDwR, the articular disc becomes displaced during mandibular movement but returns to its normal position during opening, commonly producing a clicking sound. Although disc displacement can occur in asymptomatic individuals, repeated episodes may interfere with normal joint mechanics, alter mandibular movement, and contribute to maladaptive muscular activity. In some patients, ADDwR may progress to disc displacement without reduction, resulting in limited mouth opening, restricted lateral movement, minimal condylar translation, and deviation of the mandible toward the affected side. TMDs have a multifactorial etiology involving trauma, parafunctional activities such as clenching and bruxism, emotional stress, anxiety, depression, sleep disturbances, abnormal muscle recruitment, occlusal characteristics, and disc or bony morphology. Epidemiological evidence indicates that TMDs are particularly common among adults aged 18-60 years, with a consistent female predominance. Individuals exposed to repetitive masticatory activities and high-stress occupations may also be at increased risk. Normal orofacial function depends on coordinated activation of the jaw, tongue, lips, cheeks, palate, pharyngeal, and laryngeal muscles. Orofacial Myofunctional Therapy (OMT) consists of individualized oral and peri-oral exercises designed to retrain muscle function and improve the coordination of the stomatognathic system. OMT may promote appropriate tongue posture, nasal breathing, lip seal, swallowing, mastication, and jaw-muscle coordination. Although OMT has demonstrated benefits in several orofacial conditions, its specific role in TMD, particularly ADDwR, remains insufficiently explored. The TMJ also has a close anatomical and neurophysiological relationship with the cervical spine. Cervical muscles contribute to head stabilization during chewing, swallowing, speaking, and breathing, while convergence between trigeminal and cervical sensory pathways can facilitate pain referral between the neck and craniofacial region. Consequently, cervical postural abnormalities, instability, and impaired neuromuscular control may contribute to mandibular dysfunction and TMJ-related pain. Cervical stabilization exercises (CSE) may therefore complement OMT by improving deep cervical muscle activation, reducing excessive superficial muscle activity, and enhancing overall neuromuscular control. Current research suggests that OMT may improve pain, oral function, muscle activity, and other functional outcomes; however, the evidence remains inconclusive because many studies involve heterogeneous TMD populations, small samples, methodological limitations, combined interventions, and potential placebo effects. Most previous research has also failed to focus specifically on joint-level characteristics such as disc position, reduction mechanics, and condylar-disc coordination. Therefore, a diagnostically precise investigation of patients with ADDwR is warranted. Examining OMT combined with cervical stabilization may provide a more comprehensive rehabilitation approach by addressing both local orofacial dysfunction and associated cervical impairments. Such an integrated intervention could improve mandibular function, muscle coordination, pain, and overall TMJ-related disability. Further high-quality research is therefore needed to establish the effectiveness of combined OMT and cervical stabilization specifically in patients with ADDwR and to guide evidence-based, outcome-oriented management of this common condition.

Chronic non-specific low back pain (CNSLBP) affects pain, balance, and functional ability. This randomized clinical trial aims to compare the effects of whole-body vibration (WBV) and Pilates, both combined with conventional physiotherapy, on pain, dynamic balance, and functional performance. A total of 68 participants aged 18-40 years will be randomly assigned to either a WBV group or a Pilates group. Both groups will receive treatment three times per week for four weeks. Outcomes will be measured using the Visual Analog Scale (pain), Y-Balance Test (dynamic balance), and Progressive Isoinertial Lifting Evaluation (functional performance). The results will help determine which intervention is more effective for managing CNSLBP and guide evidence-based rehabilitation practices.

This study has important clinical, academic, and practical relevance in neuromuscular rehabilitation. Clinically, it aims to identify effective and tolerable rehabilitation strategies for individuals with Parkinson's disease by comparing Tai Chi Therapy with Qi-Gong there by supporting evidence-based physiotherapy practice and improving patient adherence. Academically, it contributes to the limited literature on comparative effectiveness of these interventions and incorporates patient-centered outcomes such as exercise perception, which are often underreported. From a practical and societal perspective, identifying a more acceptable and effective approach may enhance long-term participation in rehabilitation, potentially slow disease progression, and reduce the overall healthcare burden associated with Parkinson's disease.

The current study will be a single-blind, parallel-group randomized controlled trial involving 62 patients diagnosed with smog-induced pneumonia. The study will compare the effects of Buteyko Breathing Technique (BBT) with Incentive Spirometry (IS) on respiratory outcomes. Participants will be randomly assigned to two groups using a concealed allocation method. The experimental group will receive Buteyko Breathing Technique along with standard medical care, while the control group will receive Incentive Spirometry along with standard medical care. Both interventions will be performed twice daily for approximately 20-30 minutes per session for seven days or until hospital discharge. Primary outcomes will include oxygen saturation (SpO₂), dyspnoea severity, exercise tolerance, sputum clearance, and respiratory symptom burden. Assessments will be conducted at baseline (Day 0), mid-intervention (Day 3), post-intervention (Week 2), and follow-up (Week 4). The study will be conducted at the pulmonary wards of Combined Military Hospital (CMH) and The Indus Hospital, Lahore. The hypothesis is that Buteyko Breathing Technique may produce greater improvements in oxygen saturation, dyspnoea reduction, exercise tolerance, and sputum clearance compared with Incentive Spirometry in patients with smog-induced pneumonia.

Chronic Non-Specific Low Back Pain means pain in the lower back that lasts for more than 3 months and does not have a serious cause like a fracture, infection, or nerve damage. It is very common and affects many people at some point in their lives. This type of back pain usually happens because the muscles that support your spine become weak or do not work properly. It can also be linked to poor posture, sitting too long, lack of exercise, stress, or anxiety. Over time, this can lead to stiffness, reduced movement, and difficulty doing daily activities. Treatment mainly focuses on exercise and staying active. Simple physiotherapy treatments like stretching, strengthening, and heat therapy can help reduce pain, but they may not fully improve the deeper muscles that support your back. Two helpful exercise approaches are: Mind-Body Pilates: This involves slow, controlled movements with proper breathing. It helps improve posture, strengthen core muscles, and reduce stress. Pressure Biofeedback Training: This uses a small device to help you learn how to correctly activate deep abdominal muscles that support your spine. Both methods can reduce pain and improve movement. Pilates focuses on whole-body control and relaxation, while biofeedback training focuses more on activating specific muscles. In simple terms, regular exercise, good posture, and learning how to properly use your core muscles are key to managing long-term back pain and improving your quality of life.

impairments that limit functional independence. This study aims to develop and validate a bilingual (English and Urdu) mobile application to improve upper limb function in stroke survivors through structured, task-oriented exercises. It will be conducted in two phases: app development and validation, followed by a pilot randomized controlled trial. A total of 20 participants will be recruited using convenience sampling and randomly assigned to either a clinical exercise-based group or an app-based training group, with allocation concealment ensured through sealed envelopes. The study will follow a double-blinded design, where both participants and the outcome assessor will be blinded. Outcomes will be measured using the Wolf Motor Function Test (WMFT), Fugl- Meyer Assessment (FMA), and Nine Hole Peg Test (NHPT). The study aims to provide an accessible, evidence-based digital solution to enhance functional recovery and improve quality of life in stroke survivors.

This study aims to evaluate the effectiveness of two physiotherapy techniques-Myofascial Release and Dry Cupping-in improving pain, muscle length, and functional disability in IT professionals with trapezitis. Trapezitis is a common musculoskeletal condition caused by prolonged static postures and repetitive strain, leading to neck and shoulder pain, reduced muscle flexibility, and functional limitations that affect daily activities and work performance. Although both myofascial release and dry cupping are commonly used in clinical practice, limited evidence exists comparing their effectiveness in this population. Participants diagnosed with trapezitis will be randomized into two groups: Group 1 will receive myofascial release along with routine physical therapy, and Group 2 will receive dry cupping therapy along with routine physical therapy. The interventions will be administered multiple times per week over a specified duration, and participants will be assessed before and after treatment. Outcome measures will include pain intensity using the Numeric Pain Rating Scale (NPRS), muscle length of the upper trapezius, and functional disability using the Neck Disability Index (NDI). The study will compare the effects of both interventions, focusing on pain reduction, improvement in muscle flexibility, and enhancement of functional ability. The findings may help in identifying the more effective treatment approach and contribute to improved management strategies for trapezitis among IT professionals.

This study will be a single blind, parallel group randomized controlled trial designed to evaluate the effectiveness of Barre-based core stability training with and without the Tupler Technique in postpartum women with Diastasis Recti Abdominis. A total of 58 eligible participants will be recruited from postpartum care units and randomly assigned in a 1:1 allocation ratio to either an experimental group receiving Barre-based core stability training combined with the Tupler Technique or a control group receiving Barre-based core stability training alone. Both interventions will be delivered under supervised conditions three times per week for 8 weeks, with each session lasting approximately 30-45 minutes. The Barre-based program focuses on controlled low impact movements aimed at improving deep core muscle activation, postural alignment, and neuromuscular coordination. The experimental group will additionally receive the Tupler Technique, which includes abdominal splinting, progressive core strengthening exercises, and neuromuscular re-education targeting approximation of the rectus abdominis muscles and improved abdominal wall function. Outcome measures include inter-recti distance, core strength, and pelvic floor function. Secondary outcomes include postural stability and functional performance. Assessments will be conducted at baseline, mid-intervention (week 4), post-intervention (week 8), and follow-up (week 12) by blinded outcome assessors to minimize bias. The purpose of this trial is to determine whether combining the Tupler Technique with Barre-based core stability training provides superior improvements in abdominal separation, core strength, pelvic floor function, and functional ability compared with Barre-based training alone in postpartum women.

The current study will be a single-blinded, two-arm parallel group randomized clinical trial involving 48 participants. The trial will compare Pressure Biofeedback training with Bolster Foam Roll training. Interventions will be delivered three times per week for eight weeks. The primary outcomes will include pain intensity, functional status, and muscle activation. Assessments will be conducted at baseline (week 0), mid-intervention (week 4), post-intervention (week 8), and follow-up (week 12). The study will be conducted at the outpatient departments of Sir Ganga Ram Hospital (SGRH) and Mayo Hospital Lahore. The hypothesis is that there is a difference between Pressure Biofeedback Training and Bolster Foam Feedback Training regarding pain reduction, muscle activation, and patient-reported quality of life compared to Bolster Foam rolling training among knee osteoarthritis patients.

Cervical radicular pain (CRP) is a musculoskeletal condition characterized by neck pain radiating to the upper limb due to compression or irritation of cervical nerve roots. It significantly affects daily activities, cervical mobility, and overall quality of life. Conventional physical therapy focuses on reducing pain and improving function; however, there is limited evidence comparing the effectiveness of different stretching techniques used in clinical practice. This randomized controlled trial aims to compare the effectiveness of Myokinetic Stretching Technique (MST) and Post Facilitation Stretching (PFS) on pain intensity, cervical range of motion, and functional disability in patients with cervical radicular pain. A total of 70 participants with cervical radicular pain (\>4 weeks) will be randomly allocated into two groups: Group A (Myokinetic Stretching Technique Group) - receiving MST along with conventional therapy including hot pack application, cervical isometric exercises, neurodynamic gliding, and continuous cervical traction. Group B (Post Facilitation Stretching Group) - receiving Post Facilitation Stretching along with the same conventional therapy. The intervention will be conducted for 4 weeks, with 3 sessions per week on alternate days, each session lasting approximately 45 minutes. Outcome measures will include: Pain intensity assessed using the Visual Analogue Scale (VAS) Cervical range of motion measured using a goniometer Functional disability assessed using the Neck Disability Index (NDI) This study aims to determine the more effective stretching technique for reducing pain, improving cervical mobility, and enhancing functional outcomes, thereby supporting evidence-based physiotherapy practice in managing cervical radicular pain.

This study holds significant importance as it directly addresses the need for effective physiotherapy interventions in patients with sacroiliac joint dysfunction, a condition that contributes substantially to lower back pain and disability. By comparing the effects of Fascial Manipulation and Muscle Energy Technique on pain pressure threshold, disability, and range of motion, the study provides evidence-based guidance for clinicians in selecting the most appropriate treatment. The findings can help physiotherapists develop more targeted rehabilitation plans, improve patient outcomes, and reduce treatment time. Additionally, this research adds to the limited literature available on stecco fascial manipulation and muscle energy technique approaches for SI joint dysfunction and may encourage further studies to refine and expand conservative management strategies. Ultimately, the study benefits both healthcare professionals and patients by promoting more efficient, safe, and effective physiotherapy care.

Mechanical neck pain (MNP) is characterized as neck discomfort mostly originating from musculoskeletal components such as cervical facet joints, intervertebral discs, ligaments, and musculature, in the absence of indications of nerve root compression or severe pathological conditions. Although recent evidence supports the use of both cervical and thoracic mobilization for mechanical neck pain, there remains limited comparative research examining their combined or relative effects on pain, functional disability, and quality of life. A total of 66 Participants with mechanical neck pain (\> 4 weeks) will be randomly allocated into two groups: Group A (Cervical spine Maitland mobilization group) will receive cervical spine Maitland mobilization throughout the 8-week intervention period, with sessions conducted twice weekly from pre-treatment to post-treatment assessment, Each session will be lasted approximately 30 minutes, consisting of manual therapy followed by standardized therapeutic exercises, supervised exercises will be performed for approximately 15 minutes. Additionally, participants in both groups will be prescribed a daily home exercise program lasting 10-15 minutes. Group B (Thoracic Plus Cervical Spine Maitland Mobilization) will receive combined thoracic and cervical spine Maitland mobilization, Thoracic mobilization will be applied to the upper thoracic segments (T1-T4) using central PA Technique. Grades III and IV mobilizations for thoracic stiffness and restore extension mobility, while lower grades will be applied in cases of increased pain sensitivity. Thoracic mobilization will be delivered for approximately 6-8 minutes, after that cervical mobilization with same protocol of supervised exercise and home pan for mechanical neck pain will be used. Each treatment session will be lasted approximately 30 minutes. Outcome measures will include: Pain intensity assessed using the Visual Analogue Scale (VAS) Functional disability will be evaluated using the Neck Disability Index (NDI), Health-related quality of life will be measured using the Short Form-36 (SF-36). The primary objective of this study is to evaluate the effects of cervical spine mobilization and thoracic spine mobilization on pain intensity, functional disability, and quality of life in patients with mechanical neck pain.

This randomized controlled clinical trial aims to compare the effects of vacuum-controlled static dry cupping and vacuum-controlled dynamic dry cupping on pain intensity, lumbar range of motion, and functional disability in patients with chronic low back pain. Participants will be randomly assigned to two groups receiving either static or dynamic dry cupping along with conventional treatment. The outcomes will be assessed to determine which cupping technique is more effective in improving pain, mobility, and functional ability in individuals with chronic low back pain. \[Time Frame: Measured at baseline (pre-intervention) and after 6 weeks (post-intervention completion).

This study is a double-blind, parallel-group randomized controlled trial designed to evaluate the effectiveness of a Comprehensive Corrective Exercise Program (CCEP) with and without Instrument-Assisted Soft Tissue Mobilization (IASTM) in individuals with Upper-Crossed Syndrome (UCS). UCS is a common postural dysfunction characterized by muscular imbalance, including tightness of the upper trapezius, levator scapulae, and pectoral muscles, along with weakness of the deep cervical flexors and scapular stabilizers. This imbalance leads to forward head posture, rounded shoulders, neck pain, reduced cervical mobility, and functional limitations, particularly in individuals exposed to prolonged sedentary activities and poor ergonomic conditions. A total of 60 participants aged 18-40 years diagnosed with Upper-Crossed Syndrome will be recruited and randomly allocated into two groups. The control group will receive a structured Comprehensive Corrective Exercise Program (CCEP), while the experimental group will receive the same exercise program combined with Instrument-Assisted Soft Tissue Mobilization (IASTM). Both interventions will be administered three times per week for six weeks under the supervision of a trained physiotherapist. Outcome measures will be assessed at baseline and after completion of the intervention period. Primary outcomes include cervical range of motion, muscle strength assessed by the Deep Neck Flexor endurance test, functional disability measured using the Neck Disability Index, and postural alignment assessed using a plumb line method. The aim of this study is to determine whether the addition of IASTM to a corrective exercise program results in superior improvements in cervical mobility, muscle strength, functional disability, and postural alignment compared to corrective exercise alone. It is hypothesized that the combined intervention will produce greater clinical improvements in individuals with Upper-Crossed Syndrome.

This study aims to compare the effects of foot core strengthening and sensorimotor re-training, each combined with routine physical therapy, on pain, functional ability, and plantar pressure in patients with Plantar Fasciitis. Participants will be divided into two groups: one receiving foot core strengthening with routine physical therapy and the other receiving sensorimotor re-training with routine physical therapy. The study will evaluate which intervention is more effective in reducing pain, improving function, and normalizing plantar pressure distribution.

Temporomandibular joint dysfunction (TMD) is a common musculoskeletal disorder affecting the jaw joint and masticatory muscles, leading to pain, limited jaw function, and reduced quality of life. Conservative management includes therapeutic exercises and manual therapy. Rocabado exercises improve jaw mechanics and posture, while the Strain Counterstrain technique reduces muscle tenderness and pain. This randomized controlled trial aims to evaluate the effectiveness of Rocabado exercises alone versus Rocabado exercises combined with the Strain Counterstrain technique in patients with muscular TMD. The intervention will be conducted over six weeks, with outcomes measured for pain, jaw function, and quality of life. The study seeks to determine whether the combined approach provides superior clinical outcomes.

This randomized controlled trial aims to evaluate the effectiveness of short foot exercises combined with focused hip and knee strengthening on pain, Q-angle, and functional outcomes in female patients with patellofemoral pain syndrome (PFPS). Thirty-eight participants aged 18-45 years will be randomly assigned to either an experimental group (short foot + hip and knee exercises) or a control group (hip and knee exercises only) for a 6-week supervised rehabilitation program.

This randomized controlled trial aims to compare the effects of clinical-based rehabilitation and synchronized telerehabilitation on pain, exercise adherence, and functional disability in patients with Grade-II cervical spondylosis. A total of 52 participants will be randomly allocated into two parallel groups. Both groups will receive a standardized 6-week rehabilitation program, including cervical mobility exercises, strengthening, isometric exercises, stretching, and Mulligan self-mobilization techniques. The clinical group will receive in-person physiotherapy, while the telerehabilitation group will undergo real-time supervised sessions via video conferencing. Outcome measures will include pain (Numeric Pain Rating Scale), functional disability (Neck Disability Index), and exercise adherence (Exercise Adherence Rating Scale), assessed at baseline and post-intervention. The study aims to determine whether synchronized telerehabilitation is as effective as clinical-based rehabilitation and may provide a more accessible alternative for delivering physiotherapy care.

Chronic non-specific neck pain is a common musculoskeletal condition affecting a large proportion of the population worldwide. It is characterized by persistent neck pain lasting more than three months without a specific underlying pathology. Many patients experience ongoing symptoms such as pain, reduced range of motion, functional limitations, and psychological factors like kinesiophobia, which can negatively affect recovery and quality of life. Conventional physiotherapy, including supervised clinic-based rehabilitation, is widely used for the management of chronic non-specific neck pain. These programs typically involve exercise therapy and patient education; however, access to regular in-clinic treatment can be limited due to factors such as travel, cost, and time constraints. Telerehabilitation has emerged as an alternative approach that allows delivery of physiotherapy services through online platforms, improving accessibility and convenience for patients. In addition, pain neuroscience education (PNE) is an evidence-based strategy that helps patients understand pain mechanisms, reduce fear-avoidance behaviors, and improve treatment outcomes when combined with exercise therapy. Although both telerehabilitation and supervised clinic-based rehabilitation are effective, there is limited evidence directly comparing these two approaches when combined with standardized pain neuroscience education. Therefore, this randomized controlled trial aims to compare the effects of telerehabilitation with pain neuroscience education and supervised clinic-based rehabilitation with pain neuroscience education on pain intensity, functional disability, and kinesiophobia in individuals with chronic non-specific neck pain.

Stroke is a clinically delineated syndrome, which is characterised by an acute, focal neurological deficit resulting from vascular injury (infarction or haemorrhage) within the central nervous system. Notably, around 80 percent of stroke survivors experience post-stroke deficits in upper extremity (UE) motor performance, impacting grip strength, dexterity, and functional independence, which greatly hinder the ability of stroke patients to carry out activities of daily living (ADL), and in turn affects their overall quality of life (QOL).One potential solution to these difficulties is the creation of rehabilitation robotic devices that incorporate hand technology and electrical stimulation. Although soft robotic assistive devices and electrical stimulation have each shown positive effects on motor recovery, their combined use has yet to be thoroughly investigated. This study intends to determine if the simultaneous application of these therapies can speed up rehabilitation results in comparison to independent therapies. Stroke Participants will be divided into two groups, Experimental group and Control group. Both the groups will receive intervention for 40 min/day, 03 days/week, for 08 week and measurements will be taken prior to the treatment, after 4 weeks of treatment and 8 weeks post-treatment.

This study aims to determine whether transcutaneous vagus nerve stimulation (tVNS) via auricular or cervical branches enhances recovery when combined with task-specific training in subacute stroke patients. We anticipate finding that both stimulation methods may improve upper limb motor function compared to conventional therapy. The research is expected to reveal specific cognitive domains (attention, memory, executive function) that benefit most from each stimulation approach, while also demonstrating meaningful improvements in patients' quality of life measures. These findings may make a significant practical contribution by providing clinicians with evidence-based guidance on suitable tVNS approach for improving functional independence and quality of life for stroke survivors.

Cerebral palsy (CP), particularly the spastic diplegic subtype, is characterized by motor impairments such as spasticity and mobility limitations. In addition to motor dysfunction, children with CP often experience cognitive impairments affecting decision-making, problem-solving, working memory, selective attention, and inhibitory control. These non-motor challenges contribute to reduced social interaction and quality of life. Hand-Arm Bimanual Intensive Therapy Including Lower Extremity (HABIT-ILE) has demonstrated improvements in gross motor function among children with spastic CP. However, evidence regarding its impact on cognitive outcomes remains limited. This randomized controlled trial (RCT) aims to evaluate the effects of HABIT-ILE compared with conventional therapy on both motor and cognitive functions in children with spastic diplegic CP. By addressing both upper and lower limb the research seeks to provide a comprehensive therapeutic approach that may yield more significant developmental benefits. Ultimately, the findings could inform the interventions for improving outcomes in pediatric populations affected by diplegic cerebral palsy. Participants will receive 90 hours of intervention, with assessments conducted at baseline, mid-intervention, and post-intervention. The study will investigate outcomes across motor domains and cognitive functions such as inhibitory control and working memory. Findings are expected to inform comprehensive therapeutic approaches to improve developmental outcomes and quality of life in pediatric populations affected by spastic diplegic CP.

This study is a single-blind, two-arm parallel-group randomized controlled trial designed to evaluate the effects of core stabilization exercises combined with rotational angular breathing exercises on adolescents with idiopathic scoliosis. Participants aged 10-18 years with a Cobb angle between 10° and 25° will be randomly assigned to either an experimental group receiving a structured exercise program or a control group receiving standard care. The intervention will be conducted over 12 weeks, with outcomes assessed at baseline, post-intervention, and follow-up periods. Primary outcomes include Cobb angle, angle of trunk rotation, inspiratory capacity, and spinal appearance. The study aims to determine whether the combined exercise approach is more effective than standard care in improving spinal alignment, respiratory function, and physical appearance.

The current study is a single-blind, parallel-group randomized controlled trial involving 108 participants with diabetes during pregnancy. The trial will compare leg ergometer with arm ergometer. Interventions will be delivered three times per week for eight weeks. The primary outcomes are glucose, exercise tolerance, weight, and psychological stress. Assessments will be conducted at baseline and after eight weeks. The trial will be carried out at Jinnah hospital, Services hospital, Sir Ganga Ram Hospital, Lahore. The hypothesis is that the leg ergometer including aerobic exercise will result in greater reduction in glucose and exercise tolerance, weight and stress management than arm ergometer.